An innovative approach to managing diabetes in a large urban public health system

African Americans and Hispanics suffer disproportionately from diabetes and its complications. Several barriers accounting for this disparity have been cited including lack of access to culturally competent care resulting in poor diabetes self-management education/skills. A culturally and ethnically diverse multidisciplinary network diabetes program (NDP) has been implemented in a large urban public health system servicing under/uninsured minorities with 40,000 diabetic patients. The (NDP) is composed of endocrinologists, certified diabetes educators, nurse practitioners, psychologists and social workers. The program addresses the diabetes disparity with a two tiered approach; directly managing patients with diabetes and by providing intense diabetes training to our primary health care physicians and nurses. Examples of innovative strategies employed in our system include: diabetes patients who are newly diagnosed or recently discharged from the hospital can “walk-in” without an appointment;patients not-attaining treatment goals are enrolled in our “last chance” clinic which includes intensive counseling by a multidisciplinary team; physicians and nurses participate in an annual 2-3 day “hands on” training program aimed to enhance diabetes management and teaching skills. The entire system is committed to attaining the recommended ABC diabetes targets for A1C, blood pressure and cholesterol. The mean A1C for our diabetes population has decreased from 8.8% to 7.8% since the inception of this program and the fraction of controlled patients (A1C<7%) increased from 18% to 42%, reaching national levels. In conclusion, employing a culturally appropriate system wide multidisciplinary approach in a large public health system effectively addresses the disparity among minorities with diabetes.